HomeMy WebLinkAboutMortgage_Davis (24)Form 5 RnisM 19e0 Filinp Fre SLV)
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� CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE FILED IN PERSON OR BY NAIL IN DUPLICATE EACH yEAR 81' THE OWNER R'ITH THE COUNTY AUDITOR
,t ^ (IN K'HICH THE PROPERTy IS LOCATF;D) BETN'EEN �MARCH 1 ANU MAY I0, INCLUSIVE
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� � I •••QUALIFICATIO�S O\ BACK'^ �
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STATE
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IFUIl. AANEI
certify that I, (We) was/were legal resident(s) of the State of Indiana and ow�neds) of real property on March 1, 19 �Z and that this
statement is made for the purpose of obtaining a deduction from tha[ real property loca[ed in Taxing Distric[ (City, Tou•n, Township)
�� • �z/3'��"� Described to wit
C,egal Description/oc Key I�umber ' "' • �`-'� `/`� �� /`�" ��—� -� I � �--" �w• ' � ^
� Name on property tax records if different from above
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z Are you the sole legal or equitable owner of the real estate? 7'es
Hr �� IC no, what is your exact share of interes[ in it?
� Assessed value of real estate as of March 1, cunent year �� �P o0 — /-2...30
� Amount of Mortgage or Contrac[ Indebtedness unpaid as o( n7arch 1, curren[ year $' ��Q.w
� Tiortgage recorded' ����% Coun[y Rernrder's Office, Record No. � Page a� J
W PHRPHTUAL 9AVING9 �
� Name and address of mortgagee or contrac[ seller And LOAN ASSOCIATION
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�. Do you know if there is any assignee or bona �de owner or holder of the mortgage or rnntrac[? Yes _ No � If yes,
��'what is the name and residence?
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zDoes the owner of the above described real
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property ou•n real proper[y in any other Counh• in [he State of Indiana?
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�j' 1'es No If yes, what County and Taxing District? '
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Q Has this deduc[ion been requested on that property for the current year? Yes
(/� . Amount Allowed �`Y� a
E COUNTY BOARD OF REV E��
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(.Wy APPROVED I\ AMOUNT OF S �a��
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'See False Statement Penalty Below f O r/ �� �
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